Poster Presentation Sydney Spinal Symposium 2026

Co-Design of the Virtual or In-person Physiotherapist-led Evaluation of Referrals to spine surgeons (VIPER) model of care (#115)

Andrew R Gamble 1 2 , Giovanni E Ferreira 1 2 , Christopher G Maher 1 2 , David B. Anderson 1 , Tarcisio Folly de Campos 1 2 , Joshua Hutton 1 2 , Mouna Sawan 1 , Ian Harris 3 , Leanne Hassett 1 2 , James Van Gelder 4 , Mark Halliday 4 , Chris Williams 1 , Monika Boogs 1 5 , Sam Adie 6 , Rowena Charteris 1 2 , Deborah Fullwood 1 , Edd Riley Gibson 1 , Karen Tambree 1 , Emma Molineux 1 , Laurent Billot 7 , Saurab Sharma 8 , Adam de Gruchy 1 2 , Abby Haynes 1 2 , Edith Wong 1 , Bruce Donald 6 , Scott Collins 6 , Joshua R Zadro 1 2
  1. The University of Sydney, Sydney, NSW, Australia
  2. The Institute for Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia
  3. The University of New South Wales, Sydney, New South Wales, Australia
  4. Concord Repatriation General Hospital, Sydney, New South Wales, Australia
  5. Pain Australia, Mawson, Australian Capital Territory, Australia
  6. John Hunter Hospital, Newcastle, NSW, Australia
  7. The George Institute for Global Health, Sydney, NSW, Australia
  8. NEURA, The University of New South Wales, Sydney, New South Wales, Australia

Background:

Low back pain affects 4 million Australians and creates considerable health service delivery challenges in Australia. In many cases these patients have not tried effective non-surgical care but can wait 1-2 years or more to see a spine surgeon while they develop symptoms which become more complex and costly to manage. A promising solution that optimises existing healthcare workforce capacity is a triage and management service where physiotherapists screen ‘non-urgent’ referrals to spine surgery clinics and determine their suitability for non-surgical management.

Objective:

To co-design the VIPER model of care so that it is user-centred and acceptable to adults with low back pain or lumbar spine related leg pain, clinicians and key stakeholders.

Methods:

Experience-Based Co-Design (EBCD) methodology was used to co-design VIPER, a physiotherapist-led triage and management model of care for adults with low back pain or lumbar spine related leg pain who do not require urgent surgery (e.g. rapidly progressive radiculopathy) but are referred to see a spine surgeon at public hospitals in Australia. Three online workshops were conducted via Zoom with patients with lived experience of low back pain or lumbar spine related leg pain, clinicians (surgeons, physiotherapists, rheumatologists, pain specialists, registered nurses) and key stakeholders (Healthcare organisation representatives, head of departments).

Results:

The first workshop included 8 patients, the second included 16 clinicians and key stakeholders, and the third included 7 patients, 5 clinicians, and 2 key stakeholders. Three themes emerged from the workshops, each comprising two subthemes: (1) Establish trust from the outset; (2) Optimise communication and care coordination; and (3) Define intervention targets and what matters to patients.

Conclusion:

The final co-designed VIPER model of care was deemed user-centred and acceptable to patients, clinicians and key stakeholders, and is currently being evaluated in a large multi-site randomised controlled trial.